Provider Demographics
NPI:1568041275
Name:MICHAELSON, TAMARA L (MSW, CSAC, LCSW)
Entity Type:Individual
Prefix:MISS
First Name:TAMARA
Middle Name:L
Last Name:MICHAELSON
Suffix:
Gender:F
Credentials:MSW, CSAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:MAUNALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96770-0135
Mailing Address - Country:US
Mailing Address - Phone:808-658-1274
Mailing Address - Fax:
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3018-21101YA0400X
HILSW-2807104100000X
HILCSW-49661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker